Endoscopic retrograde cholangiopancreatography (ERCP) is the visualization of the pancreatic and biliary ducts by means of endoscopic injection of a contrast medium through the hepatopancreatic ampulla (the ampulla of Vater). A retrograde image of both structures can be formed on an X-ray. ERCP may be used to facilitate the diagnosis of obstructions, for example, gallstones or cholangiocarcinoma.
In performing ERCP, an endoscope or catheter may be inserted through the mouth of the patient, down the esophagus, through the stomach, through the pylorus into the duodenum to the ampulla. A catheter or cannulatome may be inserted through the lumen of the endoscope or catheter to the ampulla to deliver radiocontrast into the bile ducts and/or pancreatic duct. The structures receiving radiocontrast may then be visualized by X-ray imaging techniques such as fluoroscopy.
Devices such as a catheter, guidewire, papillotome, etc. may be sent through the lumen of the endoscope or catheter for purposes such as radiocontrast delivery, specimen biopsy, etc. These devices may become obstructed by folds of the mucosa inside the ampullae that are either natural or an effect of the endoscope and/or its device's wrinkling of the mucosa as it is inserted into the ampullae. Similar folding may occur in the intramural portion of the common bile duct (CBD) and/or pancreatic duct.
FIG. 1 is a diagram illustrating endoscope/catheter redundant mucosa fold obstruction. As an endoscope or medical catheter 10 is inserted into the ampullae 11, the CBD 13 and/or the pancreatic duct 14, folds 12 within the inner-lining of the structures may form. These folds 12 may obstruct the endoscope or medical catheter 10 and/or an elongate device such as a guidewire, papillotome, etc. that may be inserted through the endoscope or catheter 10.
As these folds may complicate ERCP, it is desirable to use a method and device for straightening out folds within the ampullae, bile ducts and/or pancreatic duct when performing ERCP. It is also desirable to use a method and device for aligning the bodily passageway of the ampullae, bile ducts and/or pancreatic duct with the longitudinal axis of the device so as to facilitate access through the desired bodily passageway.